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Q: Too much Mucas ( Answered,   1 Comment )
Question  
Subject: Too much Mucas
Category: Health > Conditions and Diseases
Asked by: gapgapgap-ga
List Price: $40.00
Posted: 13 Dec 2002 07:22 PST
Expires: 12 Jan 2003 07:22 PST
Question ID: 124157
I have an enormous amount of mucus in my throat it goes all the way
down to my stomach.  Almost every other night I choke on the food I am
chewing because I cannot swallow.  It gets caught in my throat.  I
have visited with doctors who have told me they cannot find the
problem.  Have you ever heard of this and is there a cure.
Answer  
Subject: Re: Too much Mucas
Answered By: kevinmd-ga on 13 Dec 2002 10:36 PST
 
Hello gap,
Thanks for asking this question.  Although I am an internal medicine
physician, please see your primary care physician for specific
questions regarding your case – please do not use Google Answers as a
substitute for medical advice.  I will be happy to answer factual
medical questions.

I will now answer your question:

“What causes mucous in the back of the throat and is there a cure?”

As you can imagine, there are many things that cause this symptom.  I
will discuss the common causes, and provide treatment options for
each. However, I must emphasize you must work with your primary care
physician to come up with an appropriate treatment plan.

To start, I used Dxplain (a computerized differential diagnosis 
program) to come up with all of the medical causes for your symptoms.

From Dxplain:

Findings:
“expectoration mucous, chronic, male”

Common causes:
Chronic bronchitis
Pulmonary emphysema
Bronchial asthma
Chronic sinusitis
Gastroesophageal reflux disease
Allergic Rhinitis
Congestive Heart Failure
Bronchogenic lung carcinoma
Cystic lung disease
Pneumococcal pneumonia

Rare causes:
Lung abscess
Asbestosis
Silicosis
Candidiasis
Bronchiectasis
Endocarditis

That is a pretty broad differential – as you can see, many diseases 
cause mucous in the back of the throat.  I will briefly discuss 
the most common causes.  I can discuss the rarer causes in a separate
question if you wish.

1) Chronic obstructive pulmonary disease (COPD - includes chronic 
bronchitis and pulmonary emphysema)

From Merck Medicus:
“COPD is a nonspecific term that refers to a defined set of breathing-
related symptoms, including chronic cough, expectoration, varying 
degrees of exertional dyspnea, and a significant and progressive 
reduction in expiratory airflow. In most patients with COPD, chronic 
bronchitis and emphysema are both present in varying portions, with 
overlapping clinical manifestations.

COPD is an umbrella term that encompasses more specific respiratory 
disorders (i.e., chronic bronchitis, emphysema, asthmatic bronchitis),
which may occur individually or concurrently. The terms chronic 
obstructive airways disease (COAD), chronic obstructive lung disease
(COLD), chronic airflow (or airways) obstruction (CAO), and chronic
airflow limitation (CAL) all refer to the same disorder.

Chronic obstructive bronchitis is characterized by cough, 
expectoration, and diminished airflow that may or may not partially 
improve after bronchodilator inhalation. Simple chronic bronchitis, a
condition of chronic cough and expectoration with normal airflow, is 
not included in the definition of COPD because chronic bronchitis 
without airflow obstruction has a good prognosis. Chronic obstructive
bronchitis differs from asthmatic bronchitis only in its relatively 
limited reversibility in response to pharmacologic agents.”
http://merck.praxis.md/bpm/bpm.asp?page=BPM01PU01

From UptoDate:
”Emphysema is a pathological term describing the abnormal permanent 
enlargement of airspaces distal to the terminal bronchioles, 
accompanied by destruction of their walls without obvious fibrosis.”
(3)

Since the two diseases are from the same clinical spectrum, the 
symptoms may overlap.  Regarding mucous production specifically, 
UptoDate says this:
“Sputum production is insidious, initially occurring only in the 
morning; the daily volume rarely exceeds 60 mL. Sputum is usually 
mucoid but becomes purulent with an exacerbation. Acute chest 
illnesses may occur intermittently, and are characterized by increased
cough, purulent sputum, wheezing, dyspnea, and occasionally fever.”
(3)

Treat all symptomatic COPD patients with inhaled bronchodilators, 
beginning with an anticholinergic agent; then, if necessary, consider
switching to or adding a beta-agonist.  Treat all patients
experiencing acute exacerbations of COPD with corticosteroids.
Consider adding theophylline to augment an inhaled anticholinergic
agent, with or without a beta-agonist.

Consider using antibiotics empirically for 5 to 7 days for
exacerbations of COPD associated with increased cough, increased mucus
volume, sputum color change, or fever.

2) Asthma

Asthma is caused by inflamed and constricted airways brought on by an
allergic reaction or an environmental trigger. It is potentially life-
threatening, but is controllable. Asthma often begins in childhood, 
even as early as infancy; however, it can occur at any age, even among
elderly individuals.

In asthma, the airways become narrowed, thereby trapping air and 
causing the lungs to become overinflated. The narrowing can occur in 
varying degrees over a short period of time, causing mild to severe 
breathing difficulty during an attack.

The classic triad of asthma symptoms include cough, wheeze, and 
shortness of breath.  However “the postnasal drip syndrome, from a 
variety of upper respiratory tract disorders, can lead to symptoms 
that include cough, wheezing, dyspnea, and/or expectoration of phlegm”
(2).

Also, in addition to the classic triad, asthma can present solely with
one of the following symptoms: “Cough with or without expectoration of
excessive mucus (bronchorrhea)” (2).

The treatment of asthma can be found here:
Merck Medicus – Treatment of Asthma
http://merck.praxis.md/bpm/bpmtables.asp?page=BPM01AL03&table=BPM01AL03T09

3) Gastroesophageal Reflux Disease (GERD)

In general terms, GERD is applied to patients with symptoms suggestive
of reflux or complications thereof, but not necessarily with
esophageal inflammation.

The most common symptoms of GERD are heartburn (or pyrosis), 
regurgitation, and dysphagia (difficulty swallowing). In addition, a
variety of extraesophageal manifestations have been described
including asthma, laryngitis, and chronic coughing.

Regurgitation is the effortless return of gastric or esophageal 
contents into the pharynx without nausea, retching, or abdominal 
contractions. Patients typically regurgitate acidic material mixed 
with small amounts of undigested food.

Dysphagia is common in the setting of long-standing heartburn. Slowly
progressive dysphagia for solids with episodic esophageal obstruction
is suggestive of a peptic stricture. Water brash or hypersalivation is
a relatively unusual symptom in which patients can foam at the mouth,
secreting as much as 10 mL of saliva per minute in response to reflux.
Pulmonary symptoms such as cough (especially nocturnal), **mucous 
production**, asthma, pulmonary fibrosis, and, in severe cases, 
aspiration pneumonia can be GERD-related. Up to 80% of asthmatics in 
one survey had typical reflux symptoms or pH monitoring evidence of 
GERD, and up to 40% had reflux esophagitis.

Treatment recommends specific diet restrictions (e.g., avoiding
alcohol, acidic foods, and bedtime snacks), elevation of the head
during sleep, and avoidance of restrictive garments, which may
alleviate symptoms of GERD.

Medical therapy for GERD involves over-the-counter (OTC) antacids and
histamine-2 receptor antagonists (H2RAs - such as Zantac or Pepcid) to
temporarily neutralize and decrease acids in patients with mild
gastroesophageal reflux disease (GERD).

Increased doses of H2RAs to patients with moderately severe symptoms
of GERD or with erosive esophagitis. Prokinetics are not agents of
choice. Proton pump inhibitors (PPIs) to patients with moderate to
severe symptoms of esophagitis or peptic strictures, or with GERD-
related asthma or laryngitis. 

4) Allergic Rhinitis

Rhinitis is defined as the occurrence of annoying nasal symptoms 
including discharge, itching, sneezing, congestion, and pressure.
Allergic rhinitis, one of the rhinitis syndromes, is associated with a
symptom complex characterized by paroxysms of sneezing, rhinorrhea, 
nasal obstruction, and itching of the eyes, nose, and palate. It is 
also frequently associated with postnasal drip, cough, irritability, 
and fatigue.

Nasal inflammation associated with allergic rhinitis can also cause 
obstruction of the sinus ostiomeatal complex, thereby predisposing to
bacterial infection of the sinuses. This process accounts for many 
cases of acute and chronic bacterial sinusitis. Symptoms of bacterial
sinusitis may include nasal congestion, mucous production, purulent 
rhinorrhea or postnasal drip, facial or dental pain, and cough. 
Purulent rhinorrhea, purulent postnasal drip, or pain in a maxillary 
tooth and persistent cough in children are the most useful predictors
of bacterial sinusitis.

Consider antihistamines, decongestants, nonsteroidal anti-inflammatory
drugs (cromolyn and nedocromil), anticholinergics, and corticosteroids
for the medical treatment of rhinitis. 

Use antihistamines or antihistamine-decongestant combinations to
control the sneezing, rhinorrhea, and congestion of mild seasonal
allergic rhinitis. Use decongestants for nasal stuffiness. 

For treating seasonal allergic rhinitis and for preventing symptoms 
caused by isolated exposure to allergens, consider using a 
nonsteroidal anti-inflammatory agent (e.g., cromolyn sodium). For more
severe cases of rhinitis, use corticosteroids as first-line therapy.

5) Cystic Fibrosis

Cystic fibrosis (CF) is the most common fatal autosomal recessive 
disease among Caucasian populations, with a frequency of one in 2000 
to 3000 live births. The usual presenting symptoms and signs include 
persistent pulmonary infection, pancreatic insufficiency, and elevated
sweat chloride levels.

CF patients suffer from recurrent bouts of upper (e.g., viral upper 
respiratory infections [VURI] and sinusitis) and lower (e.g., 
pneumonia and bronchitis) respiratory tract infections. Symptoms 
include cough, dyspnea on exertion, chest tightness, thick mucus 
production that is often green or dark yellow, chronic nasal 
congestion, and headaches suggestive of sinus pressure. They may also
have pleuritic chest pain, polyarthralgias, or a history of erythema 
nodosum or other unusual rashes.

I will not discuss the treatment and diagnosis of cystic fibrosis
here.
If this is suspected by your physician, the management is specialist-
oriented and beyond the scope of this forum.

As you can see, there are many things that can cause mucous in the 
throat.  I have discussed a few of them here.  COPD, asthma, rhinitis,
and GERD are the most common causes.  I will be happy to further 
discuss some of the more rarer diseases in separate questions if you 
wish.  Of course, the treatment for your condition depends on what
disease is causing the mucous.

Again, please consult with your primary care physician for the 
appropriate management of your individual case.

Please use any answer clarification before rating this answer.  I will
be happy to explain or expand on any issue you may have.

Thanks,
Kevin, M.D.

Internet search strategy:
No internet search engine was used in this research.  All sources were
from objective physician-written and peer reviewed sources.

Bibliography:
1) Katkin. Clinical manifestations of cystic fibrosis.  UptoDate,
2002.
2) Fanta et al. Diagnosis of asthma.  UptoDate, 2002.
3) Snider.  Diagnosis of chronic obstructive pulmonary disease.  
UptoDate, 2002.
4) Spiess et al.  Clinical manifestations and diagnosis of 
gastroesophageal reflux.  UptoDate, 2002.
5) Deshazo et al. Clinical manifestations and evaluation of allergic 
rhinitis (rhinosinusitis).  UptoDate, 2002.

Links:
Merck Medicus – Cystic fibrosis
http://merck.praxis.md/bpm/bpm.asp?page=BPM01PU07žion=brief

Merck Medicus – Chronic Obstructive Pulmonary Disease
http://merck.praxis.md/bpm/bpm.asp?page=BPM01PU01

Merck Medicus – Asthma
http://merck.praxis.md/bpm/bpm.asp?page=BPM01AL03

Merck Medicus – Gastroesophageal Reflux Disease
http://merck.praxis.md/bpm/bpm.asp?page=BPM01GA15

Merck Medicus – Rhinitis
http://merck.praxis.md/bpm/bpm.asp?page=BPM01AL07
Comments  
Subject: Re: Too much Mucas
From: tlspiegel-ga on 13 Dec 2002 22:43 PST
 
Hi gapgapgap,

Excellent answer! I'd like to add:

Dairy products may not be right for you. Milk and dairy products can
be hard on the body because of their mucus causing traits. Many people
are lactose-intolerant, probably more than realize it.

tlspiegel
Google Answers Researcher

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